Respiratory Tract Infections Due to Human Metapneumovirus in Immunocompromised Children.

BACKGROUND: The clinical presentation and management of human metapneumovirus (hMPV) infections in immunocompromised children is not well understood. METHODS: We performed a retrospective evaluation of pediatric patients with laboratory-confirmed hMPV infections and underlying hematologic malignancy, solid tumors, solid organ transplant, rheumatologic disease, and/or receipt of chronic immunosuppressants. Data were analyzed using t tests and Fisher's exact tests. RESULTS: Overall, 55 patients (median age: 5 years; range: 5 months-19 years) with hMPV infection documented between 2006 and 2010 were identified, including 24 (44%) with hematologic malignancy, 9 (16%) undergoing hematopoietic stem cell transplant, 9 (16%) with solid tumors, and 8 (15%) with solid organ transplants. Three (5%) presented with fever alone, 35 (64%) presented with upper respiratory tract infections, and 16 (29%) presented with lower respiratory tract infections (LRTI). Twelve (23%) patients required intensive care unit admission and/or supplemental oxygen ≥28% FiO2. Those with severe disease were more likely to be neutropenic (P = .02), but otherwise did not differ by age (P = .27), hematopoietic stem cell transplant recipient status (P = .19), or presence of lymphopenia (P = .09). Nine (16%) patients received treatment with ribavirin, intravenous immunoglobulin, or both. Three children (5%) died of hMPV pneumonia. CONCLUSIONS: Immunocompromised pediatric patients with hMPV infection have high rates of LRTI and mortality. The benefits of treatment with ribavirin and intravenous immunoglobulin in this patient population require further evaluation.

Introduction of a novel parechovirus RT-PCR clinical test in a regional medical center.

BACKGROUND: Although data documenting the severity and frequency of human parechovirus (HPeV) infections have been published, detection of HPeV is not routinely performed in most clinical virology laboratories. OBJECTIVE: To describe diagnostic yield, epidemiology and clinical characteristics of patients infected with HPeV during the first year using a new HPeV reverse transcription (RT)-PCR. STUDY DESIGN: We introduced an HPeV RT-PCR for the routine testing of cerebrospinal fluid (CSF) and blood samples submitted to our clinical laboratory for detection of human enteroviruses (HEV). Prospective testing of samples with retrospective analysis of medical charts was performed. RESULTS: Of the 499 clinical samples received between May, 2009 and May, 2010, 9.6% (46 patients) had HEV detected and 3.4% (15 patients) had HPeV detected. All patients infected by HPeV were <3 months old, hospitalized between June and October 2009, and all typed viruses were HPeV3. Clinical characteristics of HPeV and HEV infected infants were similar. However, patients infected with HPeV were more likely to have a normal leukocyte count in their CSF (p<0.001). One HPeV3-infected infant developed encephalitis and another developed hepatitis. CONCLUSION: In our institution, the HPeV RT-PCR was useful to diagnose a novel pathogen in infants with sepsis-like disease.